A patient from California or Arizona presents with fever, malaise, cough, and night sweats. What is the likely diagnosis and treatment?

The clinical presentation of fever, malaise, cough, and night sweats, especially in a patient from California or Arizona, strongly suggests coccidioidomycosis, also known as Valley fever. This fungal infection is endemic to the southwestern United States, particularly in those regions. The symptoms can mimic more common respiratory infections but are characteristic of coccidioidomycosis, particularly in individuals residing in or visiting endemic areas.

Coccidioidomycosis is often self-limiting, and many patients recover without treatment. However, for moderate to severe cases, especially those presenting with significant respiratory symptoms, the first-line treatment is typically with azole antifungals such as itraconazole for mild to moderate disease. In contrast, for more severe cases or those with complications (such as disseminated disease), amphotericin B is recommended due to its broader antifungal activity and effectiveness in severe cases.

Given the specifics mentioned in the question—particularly the geographical context and symptomatology—the correct response aligns with the treatment of choice for coccidioidomycosis, which would involve amphotericin B if the case were severe. The notion here is that the patient presents with symptoms indicative of a significant disease, justifying a